Gains and gaps in improving access to health care for Indigenous patients
The access of Aboriginal and Torres Strait Islander patients to medications is improving, but more could be done to identify Indigenous patients in general practice, says Jill Dixon, a project manager working in Indigenous health.
Improving identification of Indigenous patients in general practice
Jill Dixon writes:
A recent issue of Australian Doctor (8 November 2012) reported that a significant number of GPs did not know about a scheme that enables eligible Aboriginal and Torres Strait Islander patients to receive free or cheaper PBS medications.
The cost of medications has been identified as a key factor that prevents many Aboriginal and Torres Strait Islander people from obtaining optimum healthcare.
The PBS co-payment measure was introduced in 2010 to address this financial barrier and is a key measure to help close the inequity gap between Aboriginal and Torres Strait Islander people and non-Indigenous people.
The scheme has been successful beyond all projections in providing Indigenous access to vitally needed medications, especially for people with chronic conditions who previously could not afford to fill their prescriptions.
The recently released Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report says that, by June 2012 approximately 150,000 Aboriginal and Torres Strait Islander people (compared to an anticipated number of 70,000) had accessed the initiative. Ninety-six per cent of pharmacies participated in the scheme, dispensing 2.7 million prescriptions during that time.
This translates to a significant increase in the number of Aboriginal and Torres Strait Islander people being better treated for the prevention or management of chronic disease.
However, the report also claims that, while the gap is closing, there is still more to be done in ensuring access to medicines through the PBS Co-payment scheme for all Aboriginal and Torres Strait Islander people.
The most recent data (2008-2009) shows that benefits paid through the PBS scheme were about 74% of the level of expenditures for non-Indigenous people, and total expenditure was only 44% of that for non-Indigenous people.
Surprisingly, the gaps between expenditures for Aboriginal and Torres Strait Islander people and non-Indigenous people are greatest in non-remote areas, because of special provisions for pharmaceutical services for those living in remote and very remote areas.
In addition to cost, another barrier is the extent to which Aboriginal and Torres Strait Islander people access – or are known to access – primary and specialist health care services in the first place.
Mentioned in the above report is the importance of the identification of Aboriginal and Torres Strait Islander patients in those services. After all, how can a GP provide prescriptions under the PBS Co-payment measure if they don’t know that their patient is of Aboriginal and/or Torres Strait Islander origin?
Another recently released report provides some useful information here. The Bettering the Evaluation and Care of Health (BEACH) Report states that Aboriginal and Torres Strait Islander people, who constitute about 2.5% of the total population, were identified at only 1.6% of total GP encounters.
This is only marginally better than findings from 10 years ago, in the 2002-3 BEACH report, which found identification occurring at 1.2% of encounters. See the comparisons here.
We now know that the vast majority of pharmacists actively support the PBS Co-payment Measure.
However, we have no equivalent information on the percentage of general practices that identify the Indigenous status of their patients, thereby helping to start their Aboriginal and Torres Strait Islander patients on the pathway to better health outcomes.
The BEACH data suggest that routine identification in general practices is low, and this would then lead to the generally low uptake of Aboriginal and Torres Strait Islander specific health interventions.
There are many reasons for the low rates of Indigenous identification in general practice. One is that many GPs and practice staff believe that they don’t have any Aboriginal and/or Torres Strait Islander people amongst their patient group. This is often an assumption based on the location of the practice, or that their patients ‘don’t look Aboriginal’.
Some practice staff believe that Aboriginal and Torres Strait Islander people should be treated just the same as non-Indigenous patients, and so should not receive any special services earmarked for them.
The gap between the health outcomes and life expectancy rates of Aboriginal and Torres Strait Islander people is now well known, and the government Closing the Gap health initiatives are intended to address this shameful discrepancy.
All GPs and practice staff are strongly urged to participate in these measures, starting with routinely identifying the Indigenous status of their patients.
The Australian Institute of Health and Welfare (AIHW) publication National best practice guidelines for collecting Indigenous status in health data sets is the place to start.
The RACGP Standards for General Practices (4th edition) require general practices seeking accreditation to demonstrate that they ‘routinely record Aboriginal and Torres Strait Islander status in (their) active patient health records’. See the RACGP position statement.
The PBS Co-payment Measure is intended for Aboriginal and Torres Strait Islander people of any age who present with an existing chronic disease or are at risk of chronic disease and in the opinion of the prescriber would experience setbacks in the prevention or ongoing management of chronic disease if they did not take the prescribed medicine and are unlikely to adhere to their medicines regimen without assistance through the Measure. For more information, see here.